<style>

td{
	font-size:12px;
	font-family:Arial, Helvetica, sans-serif;
}

input {
	border-bottom:1px solid #000;
	margin:0 0 0 2px;
	border-top:1px solid #FFF;
	border-left:1px solid #FFF;
	border-right:1px solid #FFF;
	
}



</style>

<table width="640" cellpadding="0" cellspacing="0">
  <form action="form.php" method="post"  id="commentForm">
    <tr>
      <td class="news_text" height="30" align="center" style="font-size:24px;" bgcolor="#EFEFEF" colspan="4">&nbsp;&nbsp; Contact Us Form</td>
    </tr>
    <tr>
      <td width="28%" height="32" class="news_text"> Last Name:(<font color="#FF0000">*</font>)</td>
      <td width="22%"  class="news_text"><input type="text" name="d[lastname]" value="<!--{$doc.lastname}-->" class="required" minlength="4" size="15" /></td>
      <td width="20%"  class="news_text">First Name:(<font color="#FF0000">*</font>)</td>
      <td width="30%"  class="news_text"><input type="text" name="d[firstname]" class="required" value="<!--{$doc.firstname}-->" size="15" /></td>
    </tr>
    <tr>
      <td height="34" class="news_text">Company Name:(<font color="#FF0000">*</font>) </td>
      <td colspan="3"  class="news_text"><input type="text" name="d[company]" value="<!--{$doc.company}-->" class="required" minlength="6" size="30" /></td>
    </tr>
    <tr>
      <td height="34" class="news_text">Company Type:(<font color="#FF0000">*</font>) </td>
      <td colspan="3"  class="news_text"><u><!--{$doc.company_type}--></u></td>
    </tr>
    <tr>
      <td height="37" class="news_text">Address:(<font color="#FF0000">*</font>) </td>
      <td colspan="3"  class="news_text"><input type="text" name="d[address]" value="<!--{$doc.address}-->" minlength="10" class="required" size="40" /></td>
    </tr>
    <tr>
      <td height="35" colspan="4" class="news_text"> State:(<font color="#FF0000">*</font>)
        <input type="text" name="d[state]" value="<!--{$doc.state}-->" class="required" size="8" />
       &nbsp;&nbsp;&nbsp;&nbsp; Country:(<font color="#FF0000">*</font>)
        <u><!--{$doc.country}--></u>
        &nbsp;&nbsp;&nbsp;&nbsp;Zip Code:(<font color="#FF0000">*</font>)
        <input type="text" name="d[zipcode]" value="<!--{$doc.zipcode}-->" class="required" size="8" /></td>
    </tr>
    <tr>
      <td height="31" class="news_text">Phone:(<font color="#FF0000">*</font>) </td>
      <td colspan="3"  class="news_text"><input type="text" name="d[phone]" value="<!--{$doc.phone}-->" class="required" minlength="5" size="15" /></td>
    </tr>
    <tr>
      <td height="35" class="news_text">Email:(<font color="#FF0000">*</font>) </td>
      <td colspan="3"  class="news_text"><input type="text" name="d[email]" value="<!--{$doc.email}-->" class="required email" size="20" /></td>
    </tr>
    <tr>
      <td class="news_text" height="25"  bgcolor="#EFEFEF" colspan="4">&nbsp;&nbsp;Message</td>
    </tr>
    <tr>
      <td class="news_text" colspan="4"><textarea name="d[message]" rows="6" style="width:622px;"><!--{$doc.message}--></textarea></td>
    </tr>

  </form>
</table>
